Form preview

Get the free PEBB Extended Dependent Certification 2021

Get Form
2021 WEBB Extended Dependent Certification Guidelines for extended dependent approval be considered for enrollment in Public Employees Benefits Board (WEBB) Program health plan coverage as an extended
We are not affiliated with any brand or entity on this form
4,4
98,753 Reviews
4,5
11,210 Reviews
4,6
715 Reviews
4,6
789 Reviews

Get, Create, Make and Sign pebb extended dependent certification

Edit
Edit your pebb extended dependent certification form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your pebb extended dependent certification form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing pebb extended dependent certification online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Here are the steps you need to follow to get started with our professional PDF editor:
1
Log in. Click Start Free Trial and create a profile if necessary.
2
Upload a document. Select Add New on your Dashboard and transfer a file into the system in one of the following ways: by uploading it from your device or importing from the cloud, web, or internal mail. Then, click Start editing.
3
Edit pebb extended dependent certification. Add and replace text, insert new objects, rearrange pages, add watermarks and page numbers, and more. Click Done when you are finished editing and go to the Documents tab to merge, split, lock or unlock the file.
4
Save your file. Select it in the list of your records. Then, move the cursor to the right toolbar and choose one of the available exporting methods: save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud.
Dealing with documents is simple using pdfFiller.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
Learn more about security & compliance
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out pebb extended dependent certification

Illustration

How to fill out pebb extended dependent certification

01
To fill out the PEBB Extended Dependent Certification form, follow these steps:
02
Download the form from the PEBB website or obtain a copy from your employer.
03
Fill in your personal information, including your full name, date of birth, and social security number.
04
Provide information about the dependent you are certifying, including their full name, date of birth, and relationship to you.
05
If the dependent is your child, provide their social security number as well.
06
Check the box indicating the type of extended dependent coverage you are applying for.
07
Provide any additional information or documentation required, such as proof of the dependent's disability or proof of their status under another health insurance policy.
08
Sign and date the form.
09
Submit the completed form to your employer or the appropriate PEBB office.

Who needs pebb extended dependent certification?

01
PEBB Extended Dependent Certification is needed by individuals who want to add their dependents to their PEBB health insurance plan outside of the usual enrollment period.
02
This may include individuals who have experienced a qualifying event, such as marriage, birth/adoption of a child, or loss of other health insurance coverage.
03
Dependents who are no longer eligible for coverage under their own employer-sponsored plan may also need to complete the certification to be added to the PEBB plan.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.4
Satisfied
39 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

pdfFiller’s add-on for Gmail enables you to create, edit, fill out and eSign your pebb extended dependent certification and any other documents you receive right in your inbox. Visit Google Workspace Marketplace and install pdfFiller for Gmail. Get rid of time-consuming steps and manage your documents and eSignatures effortlessly.
Use the pdfFiller app for iOS to make, edit, and share pebb extended dependent certification from your phone. Apple's store will have it up and running in no time. It's possible to get a free trial and choose a subscription plan that fits your needs.
Install the pdfFiller app on your iOS device to fill out papers. If you have a subscription to the service, create an account or log in to an existing one. After completing the registration process, upload your pebb extended dependent certification. You may now use pdfFiller's advanced features, such as adding fillable fields and eSigning documents, and accessing them from any device, wherever you are.
PEBB Extended Dependent Certification is a form used to verify the eligibility of a dependent for benefits provided by the Public Employees Benefit Board (PEBB) in the state of Oregon.
Employees who wish to add dependents to their benefits plan under PEBB are required to file the extended dependent certification.
To fill out the PEBB Extended Dependent Certification, individuals need to provide personal information about themselves and their dependents, including proof of relationship and any requested documentation.
The purpose of the PEBB Extended Dependent Certification is to ensure that only eligible dependents are covered under the benefits plan, preventing fraud and ensuring compliance with state regulations.
The certification must report personal details such as names, birthdates, social security numbers of both the employee and dependents, as well as documentation proving the relationship between the employee and the dependents.
Fill out your pebb extended dependent certification online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview

Pebb Extended Dependent Certification is not the form you're looking for?Search for another form here.

Related Features

Revise Font in VIA with ease
Revise Symbol in OMM with ease
Faint Symbol in HWPML with ease
Vary Trademark in Csv with ease
Faint Trademark in AMI with ease

Relevant keywords

pebb hca recertification timelines yyyy erb recertify childs birth1 x2 trs stateregistered surcharges hcas recertifications webpages false suffix recertified certifications retirees misrepresent allowable retroactively illegible defrauding dependents subs

Related Forms

Form preview
suing
United states patent and trademark office commissioner for patents united states patent and trademark office
Fill Now
Form preview
form imm 5406
Pto/sb/94 (02-09) approved for use through 02/29/2012. omb 0651-0036 u.s. patent and trademark office; u.s.
Fill Now
Form preview
uspto customer number lookup
Pto/sb/125a (11-08) approved for use through 11/30/2011. omb 0651-0035 u.s. patent and trademark office, u.s.
Fill Now
Form preview
PTO/SB/38
This form is used to request the u.s. patent and trademark office (uspto) to retrieve
Fill Now
Form preview
can i email an applicant initiated interview request form
Find fillablearmytarptrainingcertificatejobs at
Fill Now
Form preview
REQUEST FOR ACCESS TO AN ABANDONED APPLICATION ... - uspto
Pto/sb/68 (02-10) approved for use through 07/31/2012. omb 0651-0031 u.s. patent and trademark office; u.s.
Fill Now
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.